States in Crisis:
The Grassroots Response
Mental Health System Has
Good News and Bad News
On December 13th, 2001, Governor Taft signed into law H.B. 405, the Budget Repair Bill just days after being passed by the Ohio Senate and House of Representatives. Only 6 months into a very tight biennium budget, the Governor and the General Assembly were faced with a $1.5 billion deficit over the remaining 18 months of the 2-year funding cycle. Caused by the combination of a mild recession and the effects of the devastating events of September 11th and America’s ensuing war on terrorism, Ohio elected officials were forced to conduct a series of very intense debates on how to satisfy the state’s constitutional requirement of a balanced budget. With projected tax revenues falling seriously behind projections, Governor Taft and legislative leaders negotiated a package of budget cuts and revenue enhancements designed to eliminate this huge shortfall.
Going into this process, all state-funded agencies were instructed to submit revised budgets that included cutting expenses by 3-6%. While the Ohio Department of Mental Health complied with this stringent budget cutting request, family members and mental health advocates initiated a series of intensive efforts to promote holding the publicly funded mental health system harmless from these devastating budget cuts. As a result of the efforts of Healthy Lives/Healthy Communities grass roots coordinators, NAMI affiliate members and other MH advocates from around the state, mental health services were listed as the STATE’S TOP PRIORITY FOR THE FIRST TIME IN OHIO’S HISTORY!
Across Ohio, consumers, family members, and mental health professionals are thanking Governor Taft and the members of the 124th Ohio General Assembly for supporting the system of care that hundreds of thousands of Ohioans are dependent upon. By doing the right thing and correcting past funding inequities, the public mental health system was saved from certain disaster. When the Governor, the Senate and the House passed a bill that spared this critical system $30 million in cuts and restored $23 million in past cuts, they effectively added $53 million to the base budget for Ohio’s community mental health budget!
The long-term effect of these historic actions will be felt for years. Not only does this save the system from the impending catastrophe that it faced, but it will serve to raise future allocation budgets by the same $53 million dollars. By projecting these increases out over the next few biennium budgets, it demonstrates the far-reaching impact this victory will have for Ohio’s families for many years.
Although still seriously under-funded, this budget repair bill represents a significant and unexpected victory for the consumers of mental health services and their families in this state. NAMI Ohio is also very aware of the problems this kind of favored treatment in the current process may create in future budget deliberations. Our greatest challenge may be yet to come, as we try to hold onto this gain and build on it as the FY 2004 & FY 2005 budget cycle gets under way. Mental health advocates across the state will need to commit themselves to continuing to build permanent and substantive relationships with legislators and policy makers so that we can be confident of effectively communicating the real needs of this vulnerable population in future budget battles. Bad News:
Although, the Ohio General Assembly passed a biennium budget repair bill for the state that has the effect of level, or slightly falling revenues for the Ohio Department of Mental Health. This flat budget picture, when coupled with the expectation of no additional levy dollars and the 10 year trend of inflation-adjusted budget decreases, creates an impending crisis as communities try to stretch limited resources to cover a growing need. NAMI Ohio, along with the 30 organizational members of the Healthy Communities Coalition have committed to a 24 month plan that will maintain the positive momentum of legislative educational efforts just completed in this budget process.
Ohio’s unique community mental health system gives total responsibility to the local communities. The reality is that in the state of Ohio, there are 50 community mental health systems, not just one. The reality of growing Medicaid match expenses and the effect of uncompensated inflationary pressures will combine to set the stage for possible cuts in programs at the community level. These pressures will require a renewed effort on the part of mental health advocates to stress the responsibility of community mental health funding boards to provide core services to the severely mentally disabled population. By assisting the 50 boards in prioritizing services for their SMD clients, we can build a positive, constructive path to a responsive community-based system of care.
The NAMI Ohio Budget Advocacy and Advocate For Quality Care Special Work Group is proposing a major effort to become a partner with these 50 community mental health boards as they debate allocation decisions for mental health services. The intention is for NAMI Ohio to support efforts by family members and consumers dedicated to educating these 900 ADAMH/CMH Board members statewide. By advocating effectively for the 536,000 Ohioans that would benefit from an efficient, functioning community system of care, we hope to be able to hold on to the gains we worked for in the budget process just completed in the General Assembly.
This special work group intends to establish a minimum level of services in the areas covered in the Blueprint document that was developed for our legislative education campaign. Using the NAMI Ohio Olmstead Report and language from the Ohio Revised Code describing ADAMH/CMH Board responsibilities, a presentation will be developed to offer the family and consumer perspective to these funding and planning bodies.
In conjunction with the Regional Affiliate Meetings, NAMI Ohio will facilitate training sessions that will enable these advocates to effectively deliver a 15 minute presentation to each board on this community based system of care. Each ADAMH/CMH Board will then be asked by the affiliate to allocate time at a board meeting for a NAMI presentation.
NAMI Ohio will assist in the coordination of the activities of these advocates through regular Action Alerts. These advocates will be encouraged to accept the responsibility of attending every mental health/program committee meeting and board meeting as an observer. The goal of each trained family/advocate will be to represent the conscience of the family movement as their board debates the development of a system of care that addresses all the critical issues.
The hope is that this structure will be kept in place on a permanent basis. Each year the plan will be revisited to reflect the current funding and system status.
During its annual retreat, the NAMI Ohio Board of Directors developed specific steps needed to ensure that the 50 ADAMH/CMH Boards hear our voice. By answering the following questions, our Board of Directions will develop a training manual for our local affiliates.
- Step 1: What is the NAMI Ohio role in assisting the ADAMH/CMH Boards in developing a system of care? Why should the ADAMH/CMH Boards welcome our involvement? How do we ensure reception to the presentation?
- Step 2: A brief summary of the crisis affecting our families. What is the problem that NAMI Ohio is presenting to the ADAMH/CMH Boards?
- Step 3: What is the responsibility of an ADAMH/CMH Board and how do we present these responsibilities to them?
- Step 4: What are the solutions to meeting the needs of the severely mentally disabled? How do we suggest these solutions?
- Step 5: How do we let the ADAMH/CMH Board know that this is the beginning of an ongoing effort?
With all of the progress made with the Governor and the Ohio General Assembly, we are keenly aware that they believe that they have taken care of us and during the next biennium budget process, mental health will not be a high priority. Without additional revenue, the already struggling community mental health system could collapse. NAMI Ohio is taking a proactive approach to ensure that the limited resources available are directed to the most vulnerable population served by the mental health system.
For information concerning NAMI Ohio’s advocacy project, please contact Terry Russell at (614) 224-2700 or email firstname.lastname@example.org